At a cross road what to do…. RP (Gold Standard) or Da Vinci Robotic?

whipple said:

How to compare results
My husband had the Divinci at Northwestern by Dr. Nadler. He is also Gleason 4+3 and the pathology after surgery is T3C. He is going to have radiation but we haven't met with the radiation oncologist and dont know if they will also do hormone therapy. They want to wait and let the body heal before stating the radiation. My sister inlaw just sent me this article that I think will help you. It is from Johns Hopkins Medicine Urology, A publication of the Patrick C. Walsh Prostate Cancer Research Fund. Volume V, Winter of 2009 How to compare results. If you cant find it email me at jude0818@sbcglobal.net and I will forward it to you. Best Wishes Jude

randy_in_indy said:

Debating...
I have similar stats to you which I will post below here....but prior to surgery mine looked better 3+3=6 only right side with a palpaple tumor felt in DRE. Did a MRI with coil and they said it was organ confined. So I stuck with Da Vinci surgery 12/29/09. I really never considered RP because of the down time afterward...probably not right when we are talking about cancer but I just saw all the benefits from Robotic that I liked...away from work less. quicker recovery to get back to doing things...and the nice success rate of the experienced local team here in Indianapolis. Now my post op path came back with more aggresive cancer as you can see below...and the part that is ugly for me is the extraprostatic extension that occured on both the right and left side anterior=front. I look at this as a huge ? of whether I will be dealing with this down the road again some day with radiation. The really good part of the path report is no positive margins...and the only other concer was the perineural invasion....which I found out today is extremely common on Post Op path reports because there are nerves that go into the center of the prostate and run through it so if there is cancer in there it goes to reason the nerves inside the prostate would like have invasion. I was concerned that it was with the nerves attached to the outside of the prostate which it was told most likely not...since there was none in the surgical margin which is all the tissue they take from around the entire sphere of the prostate. I like the other comment about interviewing the docs and see what they say then making a decision....I can tell from reading on here for several months that no matter what path you choose...and no matter what results you get after the choosen treatment...cancer can come back....I honestly think it's somewhat luck that determines who gets it back and who doesn't. My best advise find the one that turns you on the most with his answers and the one you feel the most confident with as far as his skill level.....what I found leading up to my surgery after I had made the decision was everyone around said ...you got the best guys....even other docs said they would use who I used if they had it and were going to do the robotic. I am now two weeks from the day from my surgery...and honestly...I could go out and play at least 9 holes...maybe even 18 tomorrow. I have never really felt tired or out of energy...I was out runining around shoping for 5 hours yesterday and yes when I got home felt a little tired but man this has been a peice of cake with the worst part for me being the bowel movements and catheter...which I had to keep an extra week and got out today...YEEEEEEEEHAWWWWWWW! I'm friken free...and actually going to the bathroom and peeing on my own. I am on my second pad since the removal at 11 am this morning but its pretty darn dry....so hope I am continent soon....I am also doing a no, no drinking a beer right now...but heck a person has to have some fun....heck its a flat two week old home brew so the carbination is not a factor...well see how the bladder reacts. Good luck with your decision! here are my full stats.

52 years old
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores
11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%
Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined
da Vinci 12/29/09 - Dr. Hollensbee & Scott
Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNO, pMX
All nerves sparred - found two additional pudendal arteries</p>

fathersson said:

Similar place
Incredible how confusing all of this can be. I was diagnosed as a gleason 6 with one core out of 12 containing less than 5% of cancer. Also 2 other cores were indicating some precancerous abnormalities.. Urologist recs robotic removal. Go for a 2nd opinion and consult with another highly reputable surgeon/urologist next week. In the meantime, I am getting hammered from anyone who cares with all sorts of reccomendation as to who to see, whether to watch and wait, what type of surgery I should get..when I should get it..and... you name it. All great input from people who truly care. That said, it kinda sucks because it confuses you as to "what to do". and I have read and researched everything and truly understand the ramifications of any decision I make...I think the advise as to whatever turns you on is right on target because in the end.. we need to feel comfortable with whom and what we choose to do.. So .. good luck and hopefully we both make the right decisions...

Best.

txbarton said:

Just because your urologist has daVinci surgeons on staff
Just because your urologist has daVinci surgeons on staff does not mean he is supportive of daVinci. My urologist advised against daVinci for me but I sought another opinion and went with daVinci on 7 Oct.

My pre-op was Gleason 3+3 with PNI. My post-op was Gleason 4+3 with cancer outside the capsule. My 8 weeks PSA was "<0.04 (undetectable)".

My 36 year old son is a pancreatic surgeon. He and my urologist who is ~65 years old both admit that daVinci is new enough that older urologists/surgeons are reluctant to accept/recommend it.

Seek another opinion befor you commit.

Good luck.

VB</p>